Healthcare Provider Details

I. General information

NPI: 1952594475
Provider Name (Legal Business Name): SUZANNA MARIE BESS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S SUITE 300
MINNEAPOLIS MN
55454-1455
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 395
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-273-7111
  • Fax: 612-273-7112
Mailing address:
  • Phone: 612-273-7111
  • Fax: 612-273-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR 180051-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: